Pregnancy and lupus

Most women with lupus can have a safe pregnancy & a healthy
baby, so long as they make sure that their disease is under control
before conceiving, & are carefully monitored by their doctor
throughout pregnancy.

Patients with lupus may have trouble getting pregnant because
of either the disease activity or the medication. Lupus patients
with the antiphospholipid antibody are at a higher risk of miscarriage,
& patients with kidney disease can become very sick during pregnancy.

Certain medications that lupus patients take may be harmful during
pregnancy, so if you are planning to have a baby, always discuss
it with your doctor first, to ensure that you are on safe medication.

Prednisone & Heparin can be taken during pregnancy. Medications
such as Cytoxan, Cyclophosphamide, Warfarin & methotrexate must
never be taken during pregnancy. There is no evidence to suggest
that Plaquenil is not safe to take during pregnancy, although many
doctors advise that you stop taking it. NSAIDs are not safe to be
taken during pregnancy, because they may induce bleeding, which
can lead to miscarriage, or prolonged labour. However, patients
with the antiphospholipid antibody are usually given low-dose aspirin
to stop their blood from clotting.

Lupus patients whose disease is active before conception can have
a still birth, or they can develop preeclampsia (toxaemia of pregnancy),
which can cause high blood pressure, swelling & transient diabetes
(comes & goes during pregnancy).

Patients with discoid lupus, drug-induced lupus, & women who
have mild SLE , which is in remission, off all medication, &
who don't have the anti-Ro (SSA) antibody & the anticardiolipin
antibody, are considered to be at a low risk of a problem pregnancy.
Patients with active lupus myocarditis, active lupus nephritis with
an elevated serum creatinine, severe & uncontrollable high blood
pressure, & those who need to receive chemotherapy during their
pregnancy, are considered at a high risk of a problem pregnancy.

Pregnancy itself can worsen symptoms or trigger a flare, although
it can sometimes bring about a remission. Patients whose lupus is
mild or moderately active at the time of conception have a 40% chance
of having no change in their disease, a 40% chance of having a flare,
& a 20% chance of improving. The foetus makes cortisone, &
by the second trimester, the mother receives this extra dose of
steroids, which can help to improve mild disease. However, there
are various chemicals that are released in pregnancy that can promote
inflammation. Most flares are usually mild & easily managed.
Mild flares, affecting the skin & joints & muscles are common
after delivery, especially in the second & eighth weeks after
delivery.

It is important for pregnant lupus patients to have an examination
by a gynaecologist/obstetrician familiar with lupus, & for them
to liase with your rheumatologist. You should have regular blood
pressure checks, urinalyses, coagulation tests, complete blood counts,
checks on complement levels & blood sugar analyses.

The chances of the baby developing lupus are extremely small.
There is a condition called neonatal lupus, in which the mother's
antibodies temporarily pass through the placenta to the baby. These
antibodies can cause the baby to develop a temporary rash, or to
develop a heartblock (the baby would need to be fitted with a pacemaker),
although this is rare. Cutaneous neonatal lupus is seen in less
than 5% of lupus patients with the anti-Ro or anti-La antibodies.

The chance of a child of a lupus patient developing lupus in childhood
& adult life is 10% for females & 2% for males. However,
up to 50% will carry autoantibodies in their blood, & up to
25% will develop an autoimmune disease in their lifetimes.

My Own Experience

After suffering an early miscarriage, I was tested for Antiphospholipid Antibodies, which came back negative. Three months later I was pregnant again, and although suffering badly with Hyperemesis Gravidarum, I gave birth to a healthy baby girl. I went on to have another girl 21 months later. I had more ultrasound scans than normal to monitor the baby's size throughout each pregnancy. I was lucky not to suffer any flares post-partum, but my lupus was "quiet" before each pregnancy began.